October, 2006 Archive

October 4, 2006, 9:46 am

What Exactly Is My Motivation In This Scene?

uhf68nursedr.jpgOh dear!

With all due respect to my colleagues who actually had this cap, I ask you:

How on earth could anyone look at this without laughing?

Oh, I’ve seen it before.

On a rack of lamb.

Definitely a 1/10 on the Emergiblog Cap Scale.

Maybe this is the reason no one wears their cap anymore.

Those who decided to ditch the cap had to wear this piece of fluff.

This would have been a deal breaker in my choice of nursing school!

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Starbucks has a thing for torch songs today.

But at least it’s Tony Bennett. I’ve liked that man since I was little!

Now, I happen to know that the Beatles’ “Revolver” is on the playlist – I saw it on Starbucks’ website.

And I know this isn’t a radio, it’s a tape they play.

So where, I ask you, are my Beatles?

Yesterday I walked in and said it felt like a Motown day. So they put on Motown for me!

That was totally cool!

But sometimes a girl just has to hear “Got To Get You Into My Life”!

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I’ve decided there is no extrinsic reward for being an efficient nurse.

The urge to excel must come from inside.

Follow my logic here.

The faster you move your patients out of your assigned rooms in the ER, the more patients you get. Therefore, the harder you work, the harder you work!

And the more efficient you are, the more you are expected to “help” those who are less so!

Make no mistake, I’m not talking about pitching in and helping a fellow nurse who is sinking under multiple admissions, patient needs and high acuity levels. We help each other out – it’s the way we are.

My derriere has been saved more times than I can count by the co-worker who “had my back”, so-to-speak. And I like to think I’ve been there for them, too.

But what happens when your payback for being efficient is getting pulled to help the same folks over-and-over?

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I have a specific example, of course.

It happened to me.

Many years ago, I worked on a Telemetry Care Unit. They had offered a modified “Baylor Plan”, meaning you would get 40 hours of pay for working two twelve-hour shifts on the weekend.

Sounds good, doesn’t it?

It was! I could work the weekend and stay per diem in the ER during the week.

Commence rolling in the bucks, baby!

Our shift was 11pm – 11am, and this was before the California staff ratios (thank you, CNA!) were in place. This meant 6-7 patients in an assignment, primary care RNs with the occasional LVN also taking a primary care assignment.

And these patients were heavy-duty! Some might be 2-3 days post-bypass with chest tubes still in. Others had post-op epidurals requiring every 30 minute checks on respiratory status.

The routine was:

  • Report (30 minutes), then assess, vital and pass midnight medications.
  • Take the new medication records that would come up from pharmacy (computerized, and this was back in the 80s!)
    • check them against the previous medication record (look for errors, discontinued medication)
    • sleuth out any problems or omissions encountered
  • Chart your initial assessment
    • This particular hospital required the use of SOAP charting (subjective sx, objective sx, assessment and plan – for those unfamiliar)
    • The assessment had to be written out in full nursing diagnosis mode, for every single finding.
      • So if your patient had chest pain you had to write: Comfort, alteration in, due to incisional pain secondary to coronary bypass surgery. Followed by, say, “circulation, potential alteration in, secondary to prolonged inactivity resulting from post-operative bedrest”
      • This meant a full two-page initial entry for the day on every patient. At least it did the way I charted. It was understood that all future assessments would be compared to your initial one, so it had to be thorough.

Needless to say, the MAR checks and the actual charting would often take you into the 0400 hour. Remember, you had to get up every 30 minutes for the 2-3 patients who needed respiratory checks and round on your other patients at least every hour and answer any call lights and give any meds scheduled after midnight.

Tired yet?

Well, then you were able to take a break of 45 minutes – no 15 minute breaks were possible, so adding 15 minutes to your lunch was a compromise. And no, this particular hospital was not represented by CNA (California Nurses Association) or any other bargaining association.

Then came the morning routine. Because of “downsizing”, the lab no longer did the morning blood draws.

Guess who did? Yep, the nurses! Commencing at the late hour of 5 am. We woke everyone up at 5 am for their blood draw, doing anyone requiring coagulation studies last because those had to be in the lab 30 minutes after the draw!

So, 6-7 phlebotomies. Then another assessment of everyone at 0600 and med passing.

Remember, I’m still doing q 30 minutes respiratory checks in the middle of all this.

Then, because we didn’t have an 0700 change of shift, I’d start getting everyone bathed before breakfast at 0830.

Oh, did I mention that in the middle of all this we were expected to review the entire care plan, which was written on pages and pages of paper, initial and date it every day and yellow out the parts that were no longer applicable?

And those were written in nursing diagnosis form, too.

I hate nursing diagnoses. Useless verbiage.

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By this time, it is “day shift” and 0900 meds were passed, some patients were handed over to the 8-hour nurses who also worked and the doctors would make their rounds meaning new orders. Transfers would come in from ICU/CCU. The usual stuff.

But every patient I handed over to the 11 am nurse was bathed, medicated and their charts were immaculate.

I’m not bragging, I was just efficient.

So, I would finish my work and begin to read the patients’ charts. Their H&Ps, their lab tests, the doctors’ progress notes. You know, get some actual background on the patient so I might better understand the care plan?

Was that so wrong?

Well, yes it was. Because the minute I was finished with MY charts, I had to run and do the respiratory checks for the nurses who weren’t done and in fact were way behind.

Okay, no problem.

But the minute I finished with MY phlebotomies, I had to go draw the patients in the next pod for the nurses who hadn’t finished theirs and in fact were way behind!

Okay, no problem.

Oh, and could I please go hang the five IV piggybacks due at 0600 for the LVN in the next pod, whose patients I knew nothing about because the RN assigned wasn’t done with their phlebotomies and was, in fact way behind?

Uh, okay, no problem.

Except that after two months I began to notice a pattern.

I was always bailing out the same nurses. Every shift. For the same reasons.

The minute I sat to catch up on my patients or do my care plans, it was perceived that I was free and so I was asked to do the other nurses’ work.

To help them out.

I couldn’t say “no” or I wouldn’t be a “team player”.

So you know what I started to do? My work started to expand to fill the time alloted to it.

In other words, I took my time charting. I took my time drawing blood. I took my time passing meds. I took my time updating care plans.

I looked busy, so therefore I was.

Am I proud of this?

Not really.

But after two months of this happening every single shift, I realized that I was being used to cover the inability of other nurses to get their work done on time.

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This is when it hit me.

The harder you work, the more you will be expected to do.

Not so much in the emergency department where the patient census fluctuates widely and we are all running to other assignments to help settle in a new patient.

But most definitely on the floors/tele units.

This is why I believe the motivation to work hard and efficiently must come from an ingrained work ethic, an internal source.

Goodness knows there isn’t a whole lot of external feedback to promote it.

You can be a “team player” and help those co-workers who are in a bind.

Just be beware of situations where that ability and willingness to assist is being exploited.

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October 3, 2006, 8:23 am

Nothing Artificial About This Intelligence: Grand Rounds!

ai

This is arguably the best film ever made.

I am absolutely fascinated by the idea, the reality of artificial intelligence.

The fact that this film was virtually ignored by the Academy Awards will go down in history as a cinematic travesty.

Say what you will about Steven Spielberg, but he did a beautiful job of incorporating Stanley Kubricks stark cinematography with a modern rendition of “Pinocchio”.

And Haley Joel Osment, whether he is seeing dead people or running from a “Flesh Fair”, is going to be the premier actor of a generation.

So what obligation do we have to the artificial, intelligent life forms we create?

It is, indeed, a moral question.

A question for the ages, perhaps.

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Please forgive my pontificating. It’s just exciting to find out that I share a passion for artificial intelligence with Dr. Kavokin, who happens to be hosting Grand Rounds at his website RDoctor Medical.

Nick’s interview with Dr. Kavokin is a must-read. His background is quite different from what you expect of a med-blogger.

And…Dr. K was nice enough to include Emergiblog as a last-minute submission. Many thanks!

Next week, Grand Rounds will be at Unbounded Medicine.

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Don’t forget! Both “Change of Shift” and “Pediatric Grand Rounds” will be here at Emergiblog this week.

Deadline for “Change of Shift” is Wednesday at 5 pm (Pacific Time).

Deadline for “Pediatric Grand Rounds” will be Saturday, October 7th at 5 pm (Pacific Time)

I made an exception this week for a post that I felt was applicable to both “Rounds”, but please remember: submissions to Change of Shift should be different than submissions to Grand Rounds.

Think of it as “One Blog, Twice the Showcase”!

Both carnivals are looking strong. Great stories. Much Kleenex required by yours truly.

Again, you can submit via Blog Carnival or kmcallister911 at yahoo dot com.

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One last note: on October 17th, Grand Rounds will be….HERE!

Yes, I am ready and willing to take on hosting the “Big Kahuna” of them all.

And now that I no longer use Blogger, I suspect a smoother time will be had by all, especially the host!

I love you, Word Press!

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October 2, 2006, 10:40 am

To Work In The Service of Life and the Living

delivery

Ummmm….

Maybe the mother never sees it because someone has a big, fat anesthesia bag over her face?

And someone better look at her abdomen, it looks like she may have two more of those in there!

I wouldn’t have known a doula from a hole in the ground when my kids were born, but I have doubt that my first child would have been born my cesearean if I had an advocate in that labor room.

Someday I’ll tell that story, maybe over on Scared to Health.

I’ll make sure my daughters know what a doula is. They’ll have a choice.

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Okay, so I’m sitting on the couch, minding my own business and half watching/listening to a John Denver special on PBS.

It’s pledge week, so they bring out the doo-wap groups, the Bee Gees and John Denver.

Now, I don’t mind telling you that back in the mid-seventies, I had a bit of a “thing” for ol’ John.

Let’s put it this way: every song in my wedding was a John Denver song.

Every one.

So all of a sudden, there is a clip of him singing “Calypso”, circa 1975 (from the Windsong album, if you’re into trivia).

And I hear the line that makes up the title of this blog entry.

BAM!

A blog post is born.

I’m telling you, inspiration comes from where you least expect it.

But I have to admit, I really hate “Sunshine On My Shoulders”.

Sorry, John.

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What a great description of what we do.

We work in the service of life and the living.

It’s pretty special when you stop to think of it.

The operative word here being “service”.

I don’t mean dealing in a service, although that is what we do.

I’m talking about service as in serving our fellow human beings.

Often at great sacrifice to ourselves and our families.

Everyone of us who work in this field has made, is making, or will continue to make sacrifices.

Daily.

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The medical student who goes into major debt for 20 years because he/she has borrowed the money to finance their education.

So they can serve.

The nursing student in their mid-40s who is finally taking the step they have considered for so long, requiring a major re-distribution of finances and more responsibilities placed on family members.

So they can serve.

The surgical resident/registrar who goes three days on minimal sleep because they are needed in surgery, where they learn their craft.

So they can serve.

The veteran RN, cynical on the outside, soft-hearted on the inside, who picks up that extra shift so her co-workers won’t have to work shorthanded.

So they can serve.

And let’s not forget the hard-working CNAs and ER techs who work holidays and weekends and stay that extra hour for their patients.

They are serving.

We are in a unique postition to see life throughout its cycle. From the moment of birth until the patient breathes their last.

We see the worst. And the best.

People tell us their most intimate secrets.

They trust us.

And that is the most humbling aspect of all.

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When I was young, I focused on the technical aspects of patient care.

The adrenaline rush.

With experience (and age) came the realization that while a patient may benefit by the care they receive, I am benefiting by actually serving the patient.

In so many different ways.

I can tell you this: if you are in the health care business for yourself/for monetary gain you will not last.

Service is a gift.

Nursing is a service.

And I may gripe about the patient load, I may moan over the “regulars” that we often see and I may dread the extra shift and the sacrifice that it will entail.

But I’m a nurse.

And I’m proud to serve.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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